Patient-oriented complaints management: the hospital duty in § 135a (2) no. 2 SGB V

Key takeaways

• The duty sits in a subordinate clause of § 135a (2) no. 2 SGB V and is part of the quality management obligation, not a service promise.
• It has no threshold and attaches to a hospital's admission to provide care, not to its size.
• The complainants it addresses are patients and their relatives, not employees.
• Because it is part of quality management, it does not end with the answer to the complainant but feeds back into improvement.
• In a provider organisation with several hospitals it has to be met per admitted hospital.

The subordinate clause that carries the duty

§ 135a (2) SGB V opens: Vertragsärzte, medizinische Versorgungszentren, zugelassene Krankenhäuser, Erbringer von Vorsorgeleistungen oder Rehabilitationsmaßnahmen und Einrichtungen, mit denen ein Versorgungsvertrag nach § 111a besteht, sind nach Maßgabe der §§ 136 bis 136b und 137d verpflichtet. Number 2 reads: einrichtungsintern ein Qualitätsmanagement einzuführen und weiterzuentwickeln, wozu in Krankenhäusern auch die Verpflichtung zur Durchführung eines patientenorientierten Beschwerdemanagements gehört.

That final clause is the provision at issue, and its position explains why it is underestimated in practice. It does not sit in its own section with its own heading but as a subordinate clause inside the quality management duty. A reader skimming the norm sees a general obligation to run quality management and misses that a concrete component is expressly named for hospitals.

The classification has consequences. Complaints management run as a voluntary service can be shaped, suspended or economised at will. Complaints management that is a statutory component of internal quality management cannot.

Who the duty falls on

For the complaints management duty the wording expressly names hospitals. The connecting factor is admission to provide care, not bed numbers, not revenue and not the form of the provider. A small specialist hospital is subject to it in the same way as a maximum care provider.

That distinguishes it from almost every officer and reporting duty it meets in clinical practice. Where other provisions are steered by thresholds, here there is none. For the assessment this means the question is not whether the hospital is large enough, but only whether it is an admitted hospital.

For providers with several hospitals it follows that the duty exists per admitted hospital. Reachability and responsibility must therefore exist at every site. Analysis and reporting line, by contrast, can be brought together, because they attach to the provider organisation and not to the individual house.

Patient-oriented: who complains and who does not

The word patientenorientiert, patient-oriented, defines the addressees and points them outward: the complainants are patients and their relatives. This duty is therefore neither the complaints body under § 13 (1) AGG, which receives complaints from employees about discrimination on the grounds named in § 1 AGG, nor the internal reporting office under § 12 (1) sentence 1 HinSchG, whose duty attaches under § 12 (2) HinSchG to normally at least 50 employees.

A hospital runs these intakes side by side. The consequence for operations is less the number of channels than the triage: it belongs in the procedure and not on the complainant's desk. Someone who complains does not have to know which provision their concern falls under; the institution has to establish and record it.

In practice that triage arises more often than the clean separation of legal bases suggests. A relative complaining about the tone on a ward can trigger a patient-oriented complaints management case; a nurse describing the same tone from her perspective triggers a different one. The same facts, two procedures, two groups of addressees.

What the duty requires operationally

The Act does not describe complaints management in detail; it assigns it to internal quality management and calls it patient-oriented. From that assignment four working points can be derived which can be scheduled and evidenced.

• Reachability. A named access route that patients can find and that also works without digital means and for relatives. A procedure reachable only through a form on the intranet does not reach the addressees of the provision.
• Handling. A documented intake, a named owner per case and a response to the complainant. Without a response the procedure lacks the closure that distinguishes it from a collection point.
• Analysis. Because complaints management is part of quality management, complaints are an input to improvement measures. A case that is handled and filed without entering any analysis does not fulfil the purpose of the assignment.
• Evidence. What is part of quality management is looked at in the context of quality assurance. What must be evidenced is therefore not only individual cases but the structure: who is responsible, how access is made known, and what followed from the complaints.

The third requirement is where most grown procedures fail. A complaints book at reception satisfies reachability and, with some discipline, handling. It does not produce an analysable structure, because it cannot be sorted by ward, cause and recurrence. Only a record carrying those attributes turns individual cases into the information quality management needs.

In context

Patient-oriented complaints management is the case of a familiar organisational task that has a statutory basis rarely cited inside the house. Run as a service topic, it becomes a negotiation about resources. Set next to § 135a (2) no. 2 SGB V, it becomes a duty with ownership, evidence and analysis.

For the provider organisation this is first a question of organisational structure and process and only then a question of tooling: named responsibilities per procedure and site, a documented triage step at intake, and a record running from intake through to the measure derived from it.

CIVAC is not a law firm and provides no legal services within the meaning of the German Legal Services Act (Rechtsdienstleistungsgesetz). This article sets out the wording and describes how the duty can be organised. The legal assessment of your individual case belongs to your legal department or your external counsel.

FAQ

Where is the hospital complaints management duty set out?

In § 135a (2) no. 2 SGB V. The number requires an internal quality management system to be introduced and developed further, which in hospitals also includes the duty to carry out patient-oriented complaints management. The duty therefore sits as a subordinate clause within the quality management obligation rather than in a provision of its own, which is one reason it is rarely cited inside the house.

From what size does it apply?

It has no threshold. The wording of § 135a (2) SGB V attaches to admitted hospitals, not to bed numbers, revenue or the form of the provider. A small specialist hospital is subject to it in the same way as a maximum care provider. For providers with several hospitals it exists per admitted hospital.

Is this the same as the complaints body under § 13 AGG?

No, the addressees differ. Patient-oriented complaints management under § 135a (2) no. 2 SGB V is directed at patients and their relatives, whereas the complaints body under § 13 (1) AGG receives complaints from employees about discrimination on the grounds named in § 1 AGG. A hospital runs both side by side, and allocating an incoming concern belongs in the procedure rather than to the complainant's own judgement.

Is a complaints book at reception enough?

For reachability it may be; for analysis it usually is not. Because § 135a (2) no. 2 SGB V assigns complaints management to internal quality management, complaints are an input to its further development. That presupposes a record that can be analysed by ward, cause and recurrence. A free-text book does not usually carry that.

Does every complaint have to be answered?

The Act does not regulate the process in detail and names no deadline in particular. From its designation as complaints management and its assignment to quality management it does follow that a case needs closure: a documented intake, a named owner and a response to the complainant. Without that closure the procedure is a collection point rather than management.